It is axiomatic that the best and easiest way to manage a comphcatlon is to prevent it from happening. Prevention of surgical complications is best  accompllshed by a thor~hpreoperative assessment and comprehensive treatment plan. Only when these are routinely performed can fie surgeon expect to have minimal complications. It is I portant to realize that even with such planning, compltcatiofis compltcatiofis occasionally occur. In situations in which the dentist has planned carefully, thecomplication is often expected and can be managed in’ a routine manner. For example, when extracting a maxillary first premolar, which has long thin roots, it is far easier to remove the buccal root than the palatal-root. Therefore the surgeon uses more force toward the buccal root than toward the. palatal root. If a root does fracture, it is then the buccal root rather than the palatal root, and the subsequent retrieval is easier. Surgeons must perform surgery that is within their own ability. -Surgeons must therefore carefully evaluate
their training and ability before deciding to perform a specific surgical task. It is inappropriate for a dentist with . limited experience in .the anagement of impacted third mol.rr» to undertake the surgical extraction of a deeply
cmlu- lded tooth . ., he incidence of operative and postoperative cornplications is unacceptably high in this situation. Surgeons must be cautio us of unwarranted optimism, which clouds their judgment and prevents them from delivering the best possible care to the patient. The dentist must keep in mind that referral to a specialist is an option that
should always be exercised if the planned surger J ts beyond the dentist’s own skill level. In sorn formations this is not only a moral obligation llli{ also a medicolegal responsibility. In planning a surgical procedure,’ the first step is always a thorough review of the patient” medical history. Several of the complications to be discussed in this chapter are caused by inadequate attention to medical histories that would have revealed the presence of a complicating factor. Patients with compromised physical status will have loca l surgfcal complications that ‘could have been prevented had the surgeon taken a more thorough medical history. One of the primary ways to prevent complications is by taking adequate radiographs and reviewing them cinefully (see Chapter 7). The radiograph must include the entire area of surgery, including the apices of the roots of the teeth to be extracted .and the local and’ regional anatomic structures, such as the maxtllary sinus and the inferior alveolar canal. The surgeon must look for the presence of abnormal tooth root morphology. After care- . ful examination of the radiographs, the surgeon must occasionally alter the treatment plan to prevent the complications that might be anticipated with a routine forceps
(closed) extraction. Instead, the surgeon should consider surgical approaches to removing teeth in such cases. After an adequate medical history has been taken and the radiographs have been analyzed, the surgeon must do the preoperative planning. This is not simply a preparation of a detailed surgical plan but is also a plan for. managing
patient anxiety and pain and postoperative recovery (instructions and modifications of normal activitv for the patient). Thorough preoperative instructions’ and explanations for the patient are essential in preventing
the majority of complications that occur in the postoperative period. If the instructions are. not thoroughly explained or their importance made clear, the patient is less likely to follow them. Finally, to keep complications at a minimum, the surgeon must always follow the basic surgical principles ..
There should always be clear visualization and access to the operative field, which requires adequate light, adequate soft tissue reflection (including lips, cheeks, tongue, and soft tissue flaps), and adequate suction. The teeth to be removed must have an unimpeded pathway for removal. Occasionally, bone must be removed and teeth must be sectioned to achieve this goal. Controlled force is of paramount importance; this means “finesse,” not “force.” The surgeon must follow the principles of  asepsis, atraumatic handling of tissues, hemostasis, and thorough debridement of the wound after the surgical procedure. Violation of these principles leads to an increased incidence and severity of surgical complications.

BOX 11-1

Prevention of Soft Tissue ijuries
1. Pay strict attenetion  soft tissue injuries.
2. Develope adequate-sized flaps.
3. Use minimal force for retraction of so{t tissue.

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